Correlation between Alt a 1 levels and clinical symptoms in Alternaria alternata-monosensitized patients.

BACKGROUND: Alternaria alternata is a risk factor for developing asthma.Alt a 1, which has been described as the major allergen in A alternata, shows a good correlation with A alternata spores only when they have germinated. OBJECTIVES: The objective of this study was to determine the correlation between spore counts and clinical symptoms in patients with allergic asthma and/or rhinitis monosensitized to A alternata. METHODS: Two types of samplers were used to determine exposure: a Burkard spore trap to collect A alternata spores and a high-volume air sampler to collect airborne particles. A total of 366 air filters were collected. Alt a 1 levels were measured by monoclonal antibody-based enzyme-linked immunosorbent assay. Eighteen monosensitized patients were asked to record their daily symptoms throughout the year. RESULTS: A alternata spores were detected throughout the year, whereas Alt a 1 was detected only between March and December. Symptoms showed positive and significant correlations with spore counts (r=0.459, P<.001), and Alt a 1 levels (r=0.294, P<.001). The correlation between spores and Alt a 1 was low. The negative binomial model proved that an increase of 10 pg/m3 in Alt a 1 levels increased the number of symptoms at a 3-day lag by 5%. CONCLUSIONS: In patients who are allergic to A alternata, Alt a 1 levels can be considered an important marker for predicting the risk of respiratory symptoms.

Oral rush desensitization to egg: efficacy and safety.

BACKGROUND: Current management of egg allergy relies on egg elimination from the diet. It does not protect patients from reactions after accidental ingestion of the food and it has a negative influence on quality of life. To solve these problems, some desensitization protocols have been described that are safe and effective, but only one study of a rush regimen for egg with a small patient sample has been published. OBJECTIVE: To evaluate the safety, efficacy and immunologic effects of an oral rush desensitization protocol for immediate egg allergy. METHODS: Subjects aged 5 years or older with symptomatic IgE-mediated allergy to hen's egg underwent a 5-day oral tolerance induction regimen and were subsequently maintained on a regular egg intake. The variables studied were the reactions that occurred during the induction regimen and follow-up and the duration of desensitization. Prick test weal size and egg white-specific IgE and IgG concentrations were monitored. RESULTS: Twenty-three patients between 5 and 17 years of age entered the protocol. Twenty (86.9%) achieved the daily intake of a whole cooked egg, 14 of them within the scheduled 5 days. One abandoned the protocol and two were changed to a slower regimen because of repeated reactions. Allergic reactions were frequent but in general were mild. No severe reactions occurred. During follow-up of at least 6 months, egg was well tolerated by all patients. Compared with baseline, skin prick test weal size and egg white-sIgE levels had fallen at 3 months, although the differences were only significant at 6 months. CONCLUSIONS AND CLINICAL RELEVANCE: The rush protocol described is useful and safe for achieving tolerance to egg within a few days but it should always be performed in a highly supervised setting. A high proportion of patients allergic to egg can effectively be desensitized using the described schedule, with the advantage of shortening the time to become protected from reactions after inadvertent ingestion of egg, with no increase in the risk compared with the earlier reported slower protocols.

Involvement of lipid transfer proteins in saffron hypersensitivity: molecular cloning of the potential allergens.

BACKGROUND: Lipid transfer proteins (LTPs) are relevant allergens, and have recently been proposed as model plant allergens from fruit, vegetables, seeds, and pollens. However, no LTP spice allergen has been characterized to date. OBJECTIVES: To identify and isolate saffron LTPs and to explore their relevance in saffron allergy. METHODS: Six patients with rhinitis and positive skin prick test (SPT) results to saffron extract were selected. Two recombinant LTPs from saffron were isolated, cloned into pPIC9 plasmid, and produced in Pichia pastoris. Immunoglobulin (Ig) E immunodetection and enzyme-linked immunosorbent assays were performed with the 2 purified allergens and with the major peach allergen Pru p 3. RESULTS: Full cDNA corresponding to 2 saffron LTP variants was isolated and expressed in P pastoris. The molecular weight of rCro s 3.01 and rCro s 3.02 was 9.15 kDa and 9.55 kDa, respectively. The sequences obtained had a 47% identity with each other and 51% and 43% with Pru p 3. Both proteins were recognized by anti-Pru p 3 antibodies. Specific IgE to the purified allergens was found in 50% of patients for rCro s 3.01 and 33% for rCro s 3.02 and Pru p 3 in the saffron-allergic patients. CONCLUSIONS: Our results indicated that rCro s 3.01 and rCro s 3.02 are minor allergens of saffron, at least in the study patients. To our knowledge, this is the first report on the implication of LTPs in spice allergy.

Decompensation of pollen-induced asthma in two towns with different pollution levels in La Mancha, Spain.

BACKGROUND: Allergic diseases have increased in industrialized countries and this increase is associated not only with genetic factors but also with lifestyle and environmental factors such as air pollution. Our hypothesis was that asthma in pollen-allergic patients from two towns with very different pollution levels in La Mancha (Spain) could be affected to a very different degree. OBJECTIVE: Our objectives were to assess the risk factors associated with decompensation of pollen-induced asthma in the two towns and to perform a comparison between the patients from Puertollano (high pollution level) and Ciudad Real (low pollution level) with respect to daily symptoms, medication used and peak-flow measurements. METHODS: We designed a cohort study with 137 patients (66 from Puertollano and 71 from Ciudad Real), conducted over 3 years (1999-2001) and including two pollen seasons. The two populations presented similar demographic and clinical characteristics. The variables studied included: area of residence, sex, age, smoking status, asthma symptoms and positive prick tests. Clinical decompensation was monitored by symptoms recorded on diary cards, twice daily peak-flow measurements and the use of protocolized medication. RESULTS: There was a clinically relevant relationship between the place of residence and clinical decompensation. The risk of clinical decompensation in patients from Puertollano was up to three times higher than that of patients in Ciudad Real (P=0.034). Furthermore, patients from Puertollano and patients with moderate asthma presented more rapid decompensation compared with patients from Ciudad Real (P=0.020) and patients with mild asthma (P=0.049). CONCLUSION: In conclusion, pollen-allergic asthmatics in Puertollano present a poorer clinical course and become decompensated earlier than those from Ciudad Real and it could be due to air pollution.

Simultaneous allergy to vine pollen and grape.

We report the case of an 18-year-old female student suffering from seasonal rhinoconjunctivitis with sensitization to pollens from vine and also from grass, olive, and Chenopodiaceae plants who had recently developed episodes of itching, maculopapular rash, and facial angioedema after eating grapes. Testing revealed positive reactions to vine pollen and grapes, and specific IgE were found for both allergens. Immunoblotting and inhibition assays revealed cross-reactivity between the allergenic structures of vine pollen and grape fruit and also among botanically unrelated pollens.

Contact dermatitis due to povidone-iodine: allergic or irritant?

A contact dermatitis due to to povidone-iodine (PI) which seemed to be a strong irritant reaction is described. Nevertheless, patch-test results suggested an allergic reaction that is cell mediated.

Occupational rhinoconjunctivitis and asthma in a wool worker caused by Dermestidae spp.

BACKGROUND: The family Dermestidae belongs to the order Coleoptera. Occupational allergy has been described in museum personnel. A 31-year-old male wool worker presenting rhinoconjunctivitis and asthma episodes probably linked to exposure to Dermestidae-infected wool was investigated. METHODS: Extracts prepared either from insect bodies or from dust from parasitized wool were used for skin prick testing (SPT), conjunctival and bronchial provocation tests and in vitro determinations. RESULTS: SPT and provocation tests were positive to both extracts. PEFR measurement demonstrated the association between the patient's symptoms and occupational exposure to Dermestidae. Specific IgE to both extracts was detected and immunoblotting revealed several protein bands from 5 to 200 kDa that were reactive to IgE from the patient's serum. CONCLUSIONS: Dermestidae exposure in wool workers when handling parasitized wool can be a cause of IgE-mediated rhinoconjunctivitis and asthma.

Allergic contact urticaria from raw potato.

A 19-year-old man exhibited symptoms of immediate urticaria and angioedema related to contact with raw potato. A prick-by-prick test with potato pulp and rub test were positive. Specific IgE to potato was positive (class 2).

Rhinoconjunctivitis and occupational asthma caused by Diplotaxis erucoides (wall rocket).

Wall rocket (Diplotaxis erucoides) is a common Crucifera plant that grows in European and American vineyards and olive groves. We present the cases of 2 farmers with rhinoconjunctivitis and asthma related to wine-growing tasks during D erucoides pollination (March-April). The aim of this work was to demonstrate that occupational symptoms were caused by D erucoides pollen sensitization. Cutaneous tests, specific IgE measurements, conjunctival and bronchial provocation tests, and peak-flow measurements during working days were performed.

Tachyphylaxis following regular use of formoterol in exercise-induced bronchospasm.

BACKGROUND: Formoterol is a highly effective therapeutic agent in the prevention of exercise-induced bronchospasm (EIB). Regular use of beta-adrenergic drugs may result in a reduction in the protective effect afforded by these bronchodilators against bronchoconstrictor stimuli. It is unknown whether this effect extends to formoterol and exercise. METHODS: We performed a randomized, double-blind, parallel clinical trial in 19 patients with EIB. Each patient received inhaled formoterol or placebo twice daily during 4 weeks. Patients performed two exercise tests in a cycle ergometer on the 1st, 14th, and 28th study days separated 3 hours from each other. A dose of formoterol was given 30 min prior to the 2nd test. RESULTS: There were significant differences in bronchoprotection between days 1 and 14 (p = .012) and between days 1 and 28 (p = .012) in the formoterol group. No differences were found in the placebo group. The evolution of the bronchoprotection index was also significantly different between the formoterol and the placebo group (p = .002) from day 1 to 28. CONCLUSIONS: Tachyphylaxis developed to the protective effect of formoterol against EIB after 4 weeks of regular dosing. Tolerance was already found on day 14, though not progressive. Formoterol should be recommended only as needed in EIB.

Patterns of immunoglobulin E sensitization to chironomids in exposed and unexposed subjects.

We present our study of four patients with occupational type I allergy to red midge larvae (group 1) who we compared with seven individuals also sensitized to red midge larvae but who had not apparently been exposed to them (group 2). All patients showed elevated specific IgE against Chironomus thummi, and positive skin prick tests (SPT) and provocation tests with red midge larvae. We carried out SPT with Dermatophagoides pteronyssinus, Acarus siro, shrimp, cockroach and common mosquito (Culex pipiens) and specific serum IgE was also determined. The red midge larvae wheal size was significantly larger in group 1 (x = 149.2 mm2) than in group 2 (x = 18 mm2). Significant differences between levels of IgE anti-C. thummi were also found in group 1 (x = 52.12 kU/l) and in group 2 (x = 1.5 kU/l). The patients in group 2 had high levels of specific IgE against other allergens (D. pteronyssinus, shrimp and/or common mosquito) and had positive SPTs with these allergens, while the patients in group 1 were only sensitized to chironomids. The IgE-immunoblotting profile was quite different in both groups. The patients in group 1 seemed to have IgE against Chi t 1, the main Chironomus allergen, while the patients in group 2 had IgE against several protein bands in Chironomus, mosquito, shrimp and D. pteronyssinus extracts, some of them with equivalent molecular weights. We believe that the patients in group 2 were sensitized to Chironomus as a result of cross-reactivity with other insect or crustacean species.

Anaphylaxis to omeprazole.

BACKGROUND: Omeprazole is a non-competitive inhibitor of the parietal cell enzyme H+-K--adenosine triphosphatase. To date, two cases of angioedema and urticaria and two cases of anaphylaxis from omeprazole have been published. OBJECTIVE: To report a new patient with omeprazole-induced anaphylaxis demonstrated by skin tests and increased serum tryptase levels. METHODS AND RESULTS: Elevated serum tryptase levels (5.1 U/L) were detected 6 hours after the onset of the anaphylaxis. Skin intradermal tests were positive with omeprazole i.v. (4 mg/mL), omeprazole capsules diluted in saline serum (20 mg/ mL), and lansoprazole (30 mg/mL). Serum specific IgE anti-omeprazole was negative. CONCLUSIONS: According to the elevated serum tryptase levels and the positive skin test results, anaphylaxis was due to use of omeprazole. We think the adverse reaction to omeprazole was induced by an IgE-mediated hypersensitivity mechanism to omeprazole itself and not to a metabolite. We have also demonstrated crossreactivity, at least by skin tests, between omeprazole and lansoprazole.

Rhinoconjunctivitis and asthma caused by vine pollen: a case report.

BACKGROUND: The vine (Vitis vinifera) is a cultivated plant that is found in some European and American countries. Its pollen gathers in small quantities during a short pollination period in the months of May and June. Allergy to vine pollen has not been previously documented. OBJECTIVE: We sought to describe a case report of allergy to vine pollen documented on the basis of anamnesis, cutaneous, provocation, and specific IgE determination tests. METHODS: An allergenic extract was obtained from collected V vinifera pollens by aqueous standard procedures. Pollen counts and pollination periods of this and other common pollens in the area where the patient became symptomatic were studied. Cutaneous tests and the presence of specific IgE to the pollen extracts were performed by prick, CAP, and RAST techniques. Bronchial and conjunctival tests with the involved pollen extracts were also carried out to identify the sensitizing allergens. Five healthy subjects and 5 pollinic patients were used as control subjects and underwent the same tests. RESULTS: Skin prick test responses with vine pollen at different concentrations were positive for the studied patient and negative for the control subjects. Patient serum revealed a total IgE titer of 334 IU/mL and a specific IgE value of 1.3 PRU/mL (RAST class 2) to vine pollen. Bronchial and conjunctival provocation test responses were also positive when the patient was challenged with V vinifera extract. CONCLUSION: Exposure to the pollen of the vineyard plants (V vinifera) can induce immunologic sensitization and rhinoconjunctivitis/asthma.

Nonpigmented fixed drug eruption caused by paracetamol.

Fixed drug eruption from paracetamol is not rare but no cases of nonpigmented fixed drug eruption caused by paracetamol have been previously described. We present the case of a woman who developed a nonpigmented fixed drug eruption following administration of paracetamol. Patch tests performed on affected and unaffected skin with paracetamol were negative. The diagnosis was made by a double-blind oral challenge with paracetamol. The patient tolerated aspirin.

Anaphylaxis to paracetamol.

We hereby present a patient suffering several episodes of anaphylaxis (generalized urticaria, dyspnea, wheezing and intense cough) a few minutes after taking different drugs containing paracetamol. Intradermal test with pure paracetamol (100 mg/ml) was positive. It was negative in six controls. Serum specific IgE anti-paracetamol (by RIA) was negative. Anaphylaxis from paracetamol is rare but has been reported. Positive skin test with paracetamol have only been rarely described.